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Achilles Tendinitis Plagues Runners

By Sara Calabro

One of the most common running injuries is Achilles tendinitis, an irritation of the Achilles tendon that causes pain or tenderness between the heel and lower calf.

Runners who are longtime sufferers of heel pain sometimes resort to cortisone shots. The New York Times last week, reporting on a new review of trials on cortisone for tennis elbow and other tendon injuries, suggested that the shots fail to address the underlying problem and, worse, may actually inhibit structural healing.

Acupuncture offers runners a more effective and safer bet for treating Achilles tendinitis.

Don’t Forget About the Muscles

Although commonly thought of as an inflammatory condition—as suggested by the “itis” suffix—Achilles tendinitis is often a misdiagnosed muscular issue. Trigger points in the gastrocnemius and especially the soleus cause these muscles to shorten, which produces chronic tension on the Achilles tendon.

A quick glance at the musculature of the calf clarifies the involvement of the soleus and/or gastrocnemius muscles in cases of heel pain. The lower portion of the gastrocnemius attaches to the top of the soleus to form the Achilles tendon.

Trigger points in these muscles can cause referred pain to the heel area. The most common soleus trigger point, labeled “TrP1″ in the picture below, refers pain to the back of the heel and lower end of the Achilles tendon, sometimes extending to the bottom of the foot. (The soleus is also looked to in cases of plantar fasciitis, another common running injury.)

There can also be some spillover referred pain to the lower leg. In addition to pain, these trigger points can cause weakness and inflexibility of the calf muscles. Excessive training exacerbates trigger points and their effects.

In addition to potentially alleviating the pain, releasing trigger points with acupuncture can function diagnostically.

As the Times article notes, it’s not entirely clear what’s happening physiologically in patients diagnosed with Achilles tendinitis.

Numerous studies have shown that overuse injuries—the category into which running injuries usually fall—may actually be degenerative rather than inflammatory. This is why current medical references are moving away from the tendinitis term and toward tendinopathy. It may also be why cortisone shots commonly offer initial pain relief, by affecting the neural receptors, but don’t prevent the problem from coming back. It’s treating what’s possibly a non-inflammatory condition with an anti-inflammatory drug.

Have an acupuncturist check for and release trigger points in the soleus and/or gastrocnemius. If the pain goes away, you’ve uncovered the root of the problem. If it doesn’t, inflammation or degenerative disease could be to blame.

Acupuncture is a much safer and less expensive way than injecting steroids to diagnose heel pain. It’s also more likely to offer long-term relief and a future that involves running.

What Started as Heel Pain Is Now In My…Jaw?

Failure to identify trigger points, particularly in the soleus, as the cause of heel pain can result in problems beyond just being sidelined at next year’s New York City Marathon.

The soleus is the primary muscle responsible for ankle dosiflexion, a subtle movement that’s actually involved in a large number of everyday movements. When these movements are inhibited for extended periods of time, we compensate and develop unsafe body mechanics, which ultimately lead to pain.

Janet Travell—who, in her book Myofascial Pain and Dysfunction: The Trigger Point Manual, subtitled the soleus chapter “Jogger’s Heel” due to the prevalence among runners—says, “Individuals with soleus [trigger points] are prone to develop low back pain because the restriction of ankle dorsiflexion leads them to lean over and lift improperly.”

In addition to back pain, Travell, in her extensive study of soleus trigger points, uncovered an unusual jaw-pain referral pattern. In rare cases, patients with lateral soleus trigger points (labeled “TrP3″ on the above picture) experienced jaw pain and spasms that were eliminated immediately upon releasing the soleus trigger point.

The Times article on cortisone has as its headline, “Do cortisone shots actually make things worse?” A better question might be, “Do they actually make things better?” If the answer is “no”—the direction research seems to be pointing—or even “I don’t know,” the next question becomes, “Why not try trigger-point acupuncture instead?” There’s a very good chance it will make things better.

Photo by Sara Calabro

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Comments

Chris Primavera
Reply

This article would help the many people I know who are suffering from all kinds of foot pain.

Bianca Beldini
Reply

Another great article AcuTake! May I add a little bit of clinical experience…

Aside from treating the Trigger Points related to the Soleus, Gastrocnemius (both medial and lateral heads) and Plantaris muscles, which all three fascially enmesh themselves into what we know as the Achilles tendon, it is IMPERATIVE that needling is performed along the medial and lateral sides of the Achilles tendon as well. The reason for this is to increase blood supply to the poorly vascularized tendon. Acupuncture, as we know, creates a vasodilation effect on tissue by way of a superficial histamine reaction. With blood, comes oxygen…with oxygen, comes an immune repair response…with the repair response comes healing of tissue and a VERY HAPPY PATIENT that may now have the option to say no to the shot of cortisone!

Happy Marathoning! ;-)

http:///www.sacredspaceacupuncture.com

Rebecca Schacker, DC
Reply

There is also a great opportunity to introduce a self care option, which is to stretch the soleus. In my experience I find that even if a runner or other athlete is taking the time to stretch (after the muscles are warm, of course), most fail to isolate the soleus. A regular calf stretch is usually done with a straight leg, which tenses the gastrocnemius. The same stretch with the knee bent will isolate the soleus since that muscle does not cross the knee joint. This should also be adressed if someone has plantar fasciitis.

Sara
Reply

Thanks so much for the input, Rebecca. Great suggestion.

Sara

J
Reply

I have had achille pain since I hurt my back a couple of years ago. I have tried all sorts of treatment with almost no help. As a last resort I went to the ortho doc and he wants to do a gasstros recession. I am not sure if I want to cut on my legs.

Since my visit with the surgeon, I have been doing self massage on the soleous and I have had pain-free days! Now I am not sure, but I think that the soleous trigger points may be the key.

Any other suggestions that can keep me on a pain-free road, without surgery.

Thank you!

h z
Reply

Great article. I am in school to become an acupuncturist and also suffer from recurring Achilles tendonitis/ tendonopathy. One thing though, and it is a minor detail. The Soleus doesn’t dorsiflex the foot, it is a muscle involved in plantarflexion. Keep up the good work!

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